Exam Pass Rates Research Articles

Remediation for NCLEX-RN success in high-risk nursing students

Background: The National Council Licensure Exam (NCLEX-RN) pass rate is often used as a measurement to determine a successful undergraduate nursing program. Students that are not successful in the first attempt of taking this exam are statistically unlikely to pass on the second attempt.Purpose: To determine if the implementation of a prescribed remediation protocol would improve undergraduate baccalaureate predictor scores for passing the NCLEX-RN exam on the first attempt for high-risk students.Methods: A retrospective cohort study design was used to compare scores of nursing students after a prescribed remediation protocol was instituted.Results: A one-way ANOVA test was conducted to compare the effect of a remediation policy on nursing students enrolled in an undergraduate nursing program. Remediation had a significant effect at the p < 0.05 level for six cohorts consisting of F (5,232) = 9.90 and a p value of 0.0000000133. Post hoc comparisons using the Tukey HSD test indicated that the comprehensive predictor exam mean score for those that received remediation was significantly different than those that did not receive remediation in like cohorts.Conclusion: A prescribed remediation protocol assisted students in achieving the necessary scores on the Comprehensive Predictor exam to increase their likelihood of success on NCLEX.

Relative United States Medical Licensing Examination (USMLE) Performance by Specialty Is Not a Predictor of Board Exam Pass Rate: The Case of Diagnostic Radiology.

IntroductionIn 2010 diagnostic radiology (DR) changed the board certification process for residents using the new Core exam. However, there is not a standardized way to evaluate DR residency graduates. With no specific target pass rate for the exam, the “appropriate” pass rate has remained a debated topic among the field. In this paper, the board certification exam passage rates of DR are compared to other medical specialties to assess the standardization method of the American Board of Radiology (ABR) and serve as basis for additional specialties considering changes to their board exam structure.MethodsPerformance on the United States Medical Licensing Examination (USMLE) was obtained from the National Resident Matching Program (NRMP) and San Francisco match. Boards passage rates were analyzed using data from the American Board of Medical Specialties. USMLE and board exam passage rates were averaged and ranked, and statistical analysis was conducted using Stata (College Station, TX).ResultsDR performance on USMLE Step 1 has increased at the lowest rate (0.563 points/year) since 2005 and anesthesiology performance has increased at the greatest rate (1.313 points/year). Residents matching from US allopathic medical schools during the 2010 and 2012 years had DR oral board exams with USMLE 1 averages of 232 and 235, respectively. First-time pass rate for the first Core exam was 87% and the overall pass rate since the first Core exam has been 88.54%. The Spearman rho coefficient for specialty ranks of board passage rate and USMLE 1 was 0.0679 (p = 0.8101). The Spearman rho coefficient for board passage rate and USMLE 2 CK was 0.1430 (p = 0.6257). The Spearman rho coefficient for USMLE 1 and USMLE 2 CK was 0.8317 (p = 0.0002).ConclusionsSpecialty board pass rates have not increased in concert with improved trainee performance on the USMLE. USMLE performance among those matching in diagnostic radiology has increased, ABR board exam passage rate has decreased. ABR determines passing thresholds to the relative performance of examinees rather than using a criterion referenced Angoff standard.

Pharmacy regulator to meet with universities over 'deeply concerning' registration exam pass rates

Pharmacy regulator to meet with universities over 'deeply concerning' registration exam pass rates

Is academic performance a zero-sum game? Exploring the nexus between research and education outcomes of U.S. accounting programs

Academics and the public have long questioned whether research and teaching are symbiotic activities, with each enhancing the other. Revisiting this question for the U.S. accounting discipline, we analyze publication output in top-tier journals and CPA exam pass rates to indicate an accounting department's total research and educational achievement. Examining data for 65 top programs from 1985 to 2016 finds that research productivity and this desired educational outcome are positively, but not significantly, related. This suggests that an accounting department's two major activities do not conflict—but also do not strongly support each other. This result is generally reproduced for different levels of research production. Some variation is observed after the CPA exam changed to its current computerized administration.

Reducing a Barrier to Entry: The 120/150 CPA Licensing Rule

In the United States, one of the most common state-level occupational licensing requirements is education. Education requirements for certified public accountants (CPAs) in many states have increased over the past few decades, but recently a few states have reduced their educational requirement to sit for the CPA exam. Using data from 2006 to 2016, we separately examine the effects of relaxing or strengthening educational requirements on the number of first-time candidates sitting for the CPA exam and on candidate performance. Our results indicate that a reduction in the number of credit hours required to sit for the CPA exam increases the number of candidates, while an increase in the number of prerequisite hours reduces the number of candidates (the latter effect is sensitive to the inclusion of control variables). We also find no relationship between changes in CPA exam requirements and pass rates or scores. Hence, requiring 150 h instead of 120 acts as a barrier to entry for potential CPAs with no accompanying increase in candidate quality.

Projecting supply and demand for pharmacists in pharmacies based on the number of prescriptions and system dynamics modeling

BackgroundPharmacists play an important role in promoting people’s health in Japan, which has an aging population. Hence, it is necessary that the distribution of pharmacists meets the population’s needs in each region. This study projects the future supply and demand for pharmacists in pharmacies to consider an optimal distribution of pharmacists.MethodsThe future supply of pharmacists working in pharmacies in Hokkaido is projected using system dynamics modeling, according to their career path. The demand is projected based on the number of prescriptions, sourced from publicly available sources. The analysis period is 2015–2040. The estimated demand is converted into the number of pharmacists and the sufficiency is evaluated using sufficiency ratio (supply/demand ratio). Sensitivity analyses of the sufficiency ratio were conducted to estimate the effects of changes in parameters such as national exam pass rate, enrollments, attrition rates, the number of prescriptions per pharmacist, and diffusion of newly licensed pharmacists.ResultsThe projected supply, in 2025 and 2040, is 1.24 and 1.56 times, respectively, as that in 2015 and the demand is 1.11 and 0.98 times, respectively. In 2015, although the sufficiency ratio in Hokkaido overall is 1.19, the ratios are higher in urban medical areas and lower than 1 in rural medical areas, such as Minamihiyama, Emmon, and Nemuro. By 2040, the sufficiency ratios are greater than 1 for all areas except for Emmon and higher than 2 in some areas. The sensitivity analyses found that the sufficiency ratio was most sensitive to diffusion of newly licensed pharmacists and the number of prescriptions per pharmacist.ConclusionOptimal distribution should be considered, as the results reveal a possible shortage in the number of pharmacists in rural medical areas in 2015–2025. Conversely, as the demand is projected to decrease after 2025 with a population decrease, future supply should be determined in order not to cause an oversupply after 2025. Refinements of the projection model should be conducted since the related factors such as the roles of pharmacists will change over time.

Higher Education Spending and CPA Exam Performance

We examine the relationship between state and local spending per capita on higher education and the performance of Certified Public Accountant (CPA) examination candidates. State and local governments play an important role in providing access to higher education at public colleges and universities. Because these government bodies face difficult choices in addressing many competing needs, there is substantial variability in the level of spending on higher education per capita across states. This state-level variation presumably leads to differences in the quality of education. We find evidence to support this view. Specifically, we find that the level of spending on higher education per capita has a positive marginal effect on the CPA exam pass rate for public universities. In contrast, the level of spending on higher education per capita has no effect on the CPA exam pass rates for private universities.

Thoracic surgery program websites: Bridging the content gap for improved applicant recruitment

ObjectiveTo evaluate the website content of all US thoracic training programs, assessing the available content to identify areas for improvement. MethodsA total of 98 accredited thoracic surgery fellowship and integrated residency programs were evaluated for the presence of 25 important online content items. Two authors assessed each website and social media page individually, and a third author resolved <4% of the initial data disagreement. The total number of alumni represented for each program was also recorded, including a breakdown of what the alumni pursued. ResultsOf the 98 accredited programs, 91 (92.9%) had a website. All 26 integrated residencies had a website, compared with 65 of 72 fellowships (90.3%). The 91 websites contained a mean of 8.2 ± 3.0 out of the 25 online content variables evaluated (33.0%), with rotation information (n = 69; 75.8%), application information (n = 65; 71.4%), program coordinator contact (n = 60; 65.9%), hospital affiliation (n = 49; 53.8%), number of positions per year (n = 49; 53.8%), and faculty listing (n = 46; 50.5%) found on ≥50% of the program websites. Areas lacking were retention rate (0% reported), social media links (n = 3; 3.3%), written and oral exam pass rates (both n = 5; 5.5%), graduate placement (n = 11; 12%), call duties (n = 12; 13.2%), cases performed (n = 17; 18.7%), and salary/benefits (n = 25; 27.5%). ConclusionsThis study identifies gaps in content for prospective thoracic surgery applicants. Important information such as retention rate, social media links, exam pass rates, outcomes of graduates, call duties, cases performed, and salary/benefits were lacking in program websites. The improvement of websites may represent a straightforward and low-cost intervention that programs can undertake to enhance the recruitment of prospective applicants.

Flipping the Classroom in Otolaryngology Residencies.

ObjectiveTo understand the use of the flipped classroom (FC) - learning core content prior to an academic session, with class time devoted to applying this content - in otolaryngology residency education.MethodsAn electronic survey of 107 otolaryngology program directors (PDs), including demographic details, the flipped classroom perception instrument (FCPI), and the otolaryngology programs' current use of FC.ResultsForty-four (41%) PDs completed the FCPI. Seventy-one point one (71.1%) of respondents were male, 60% were 30-49 years, and the remainder were older. Sixty-two percent (62%) had fellowships associated with their program, 21.7% of programs used the FC model Very Often, 17.4% Somewhat Often, 28.3% Sometimes, 17.4% Somewhat Rarely, 8.7% Very Rarely, and 6.5% Never.Attitudes toward FC principles were positive with modes “strongly agree” for all, except for “online modules enhance learning” where the mode was “slightly agree” with significantly higher scores for PDs over age 50 than for those younger (4.17 vs. 3.63, p=0.033). There were no other significant differences comparing male vs. female PDs, younger vs. older PDs, smaller vs. larger programs, programs with or without fellowships, programs with 100% vs. <100% board exam pass rates, or programs in different geographical regions. The pre-class activity mean score was 4.34 (95% CI 4.12-4.56) and the in-class mean score was 4.18 (95% CI 3.99-4.37). There was no significant correlation between the likelihood of using a flipped classroom and attitude scores.ConclusionPDs value both the pre-class and interactive in-class principles of FCs but only 37.8% of programs use FC often, suggesting that practical approaches to implementation in this group could improve education in this population.

Variability of clinical hours in prelicensure nursing programs: Time for a reevaluation?

BackgroundIn pre-licensure nursing education, there is no agreement as to the type, quantity and quality of clinical experiences that are necessary to produce a competent graduate. MethodA descriptive comparative study was conducted across four pre-licensure nursing programs to identify numbers of clinical and simulation hours within targeted clinical courses. Two Associate Degree (ADN) and two Bachelor of Science (BSN) nursing programs participated. ResultsThe final sample consisted of 271 students. Large variabilities in the number of clinical and simulation hours were identified across the four programs. Licensure exam pass rates differed by the individual programs, but there were no significant differences between the ADN and BSN programs on pass rates. ConclusionThese findings suggest that prelicensure nursing programs’ licensure examination results were not commensurate with clinical hours. Future programmatic decisions regarding clinical requirements should be based on empirical evidence instead of sheer quantity of hours.

Fact or Fiction? Practice on a Simulator is Not Required to Pass the Fundamentals of Endoscopic Surgery (FES)TM Skills Exam

Initial work on the validity evidence used to support the Fundamentals of Endoscopic Surgery (FES) performance exam as a measure of technical competency showed a strong relationship to clinical experience. Despite this evidence, there is a perception among some program directors that the exam cannot be successfully passed without practice on a simulator. We assess the validity of this perception. Deidentified data from the initial FES skills examination (prior to the 2014 FEC requirement) was reviewed, and 335 unique participants with reported simulation experience demographics were identified. Self reported data analyzed included gender, total clinical endoscopy procedure experience (1-150, 151-300, >300), and endoscopy simulator training hours (0, 1-5, 6-10, 11-20, >20). Final FES skills exam scores, and pass/fail designations for each participant were reported by the FES program staff. Continuous variables were compared between groups using one-way analysis of variance with post-hoc analysis where appropriate. Categorical variables were compared using Pearson Chi-Squared. The effect of variables on pass rate was assessed using univariate and multivariate logistic regression. Simulation training experience (SE) was categorically reported in hours(n,%): 0 (98, 29%), 1-5 (135, 40%), 6-10 (52, 16%), 11-20 (24, 7%), and >20 (26, 8%). Clinical endoscopy experience (CE), reported categorically as total cases performed (n,%), was available for 323 of 355 identified participants: 1-150 (126, 39%), 151-300 (99, 31%), >300 (98, 30%). There was no statistically discernible differences in mean FES total or task scores across the SE groups (total score 0:72 ± 15, 1-5:72 ± 13, 6-10:71 ± 14, 11-20:71 ± 16, 20:78 ± 13; p = 0.28), while both total score and task scores were discernibly higher in the more experienced CE groups (>151) compared to the least experienced group (total score; <150:67 ± 15, 151-300:75 ± 1, >300:77 ± 14; p < 0.01). Similarly, there was no statistically discernible difference in FES skills exam pass rates between SE groups (0: 80%, 1-5: 82%, 6-10: 79%, 11-20: 75%, >20: 85%; x2 = 2.5, p = 0.6), but there was a strong relationship between clinical experience and pass rate (<150: 70%, 151-300: 87%, >300: 89%; x2 = 15.8, p < 0.001). Finally, on both univariate and multivariate logistic regression, CE remained a discernible predictor of passing, even when controlling for SE (odds ratio = 2, 95% confidence interval 1.4-2.9, p < 0.001). FES skills examination data collected on participants completing the examination before the FEC requirement shows no demonstrable relationship with self-reported training experience on a simulator but confirms a strong relationship with clinical endoscopy experience. This lends further evidence to the validity of the FES exam as a marker of clinical endoscopic skill.

Pregnancy and Parenthood Remain Challenging During Surgical Residency: A Systematic Review.

To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training. The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003 to 2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined nonsurgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles. Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18%-28% vs 32%-54%). As compared with the general population, surgical residents had their first child later in life (30-34 vs 25 years old), and had fewer children overall (0.6-2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30%-32% vs 11%), as were assisted reproductive technology rates (8%-13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 overnight calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared with other residents. Despite these similar academic outcomes, negative attitudes and perceptions toward pregnancy during residency were consistently identified. Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.

Research on the small private online course (SPOC) teaching model incorporating the just-in-time teaching (JiTT) method based on mobile Internet for learning college physics

Based on mobile Internet and cognitive psychology, this study explores the effectiveness of the small private online course (SPOC) teaching model for the learning of college physics. The research involves designing and implementing the SPOC teaching model, which incorporates the ‘just-in-time teaching’ (JiTT) method, and collecting and analyzing relevant data. The statistical results show that there are significant differences in the exam mean scores and pass rates between the experimental group and the control group. They also show that students’ learning effect is obviously correlative with their online learning behavior. There is no significant difference in learning effect between different genders in the experimental group. The tendency for student participation in the online learning is upward, and nearly 94% of the students like the teaching model.

A quantitative comparative study of medical dosimetry graduates with and without prior radiation therapy certification

All but a small number of formal medical dosimetry programs require radiation therapy certification for admission. The problem is a lingering perception from the radiation oncology community that medical dosimetry students must have a prior radiation therapy certification and/or experience. There is a paucity of evidence in the literature to support the perception that prior radiation therapy certification equates to better job performance as a medical dosimetrist. The purpose of this quantitative comparative study was to investigate outcomes of medical dosimetry graduates with and without prior radiation therapy certification (RTT and non-RTT). The researcher used archival records to examine comparison data of medical dosimetry graduates with and without radiation therapy certification including track of enrollment, admissions cumulative grade point averages (CGPA) and science grade point averages (SGPA), medical dosimetry program GPAs, radiation therapy work experience, Medical Dosimetrist Certification Board (MDCB) exam pass rates, program completion rates, and job placement rates. Surveys were used to collect and analyze data from clinical supervisors at affiliate internship sites and from employers of program graduates. Key findings from the quantitative study revealed that no relevant differences existed between RTT and non-RTT medical dosimetrist graduates with regard to GPA and program effectiveness data. However, for RTT and non-RTT students combined, there were significantly lower GPAs noted for individuals who did not graduate from the program or graduates that did not pass the MDCB exam on first attempt. Thematic findings from the surveys revealed non-RTT medical dosimetrist students/graduates required more initial training and supervision and differences were noticed among the non-RTT medical dosimetrist students/graduates based on their prior degree. Clinical supervisors and employers had no reservations about hiring RTT or non-RTT medical dosimetry graduates from the program.

Student Perceptions of Barriers to Professional Exam Success

Purpose: Many Allied Health education programs have shifted attention toward program outcome measures, including professional exam pass rates. The purpose of this study was to solicit the opinions of students, in order to better understand how they perceive their barriers to professional exams, what resources have proved helpful for them, and ultimately what advice programs can give to students to increase exam success. Method: A survey was sent to 104 alumni of the Medical Laboratory Science (MLS) program at a large Midwestern university to determine what they perceived as barriers in preparing for and taking their certification exam(s), and the resources they identified as being the most or least helpful in the process. Results: Forty-two individuals responded to the survey, with two self-reporting having not passed a certification exam. Successful students reported the most beneficial tools included a purchased review manual and an online exam simulator. They reported that reviewing their own notes and materials were only somewhat helpful. The respondents, who had attempted the exam, but not yet passed, reported feeling unprepared, waiting too long after graduation and high stress levels, as the reasons for not being successful. The majority of respondents indicated the need for additional resources in preparing for professional exams. Conclusions: Educational programs can use this information to better mentor students to utilize additional resources that are available to them, design a meaningful timeline, and deal with stress before taking any professional exam.

Separate but Equal? The Sorting of USMDs and Non-USMDs in Internal Medicine Residency Programs.

The US internal medicine workforce relies on international and osteopathic medical graduates to fill gaps in residency. Little is known about the distribution and impact of IMGs, DOs, and USMDs concentrating in different types of IM programs. Determining the extent to which USMDs, DOs, and IMGs concentrate in different types of IM programs and comparing Board pass rates by program concentration. This survey study used data from the AMA's FREIDA database for 476 non-military IM programs in 2017-2018, and 2016-2018 ABIM exam pass rates for 388 accredited programs. Outcomes were (1) program concentration based on percentage of residents who were USMDs, IMGs, and DOs in 2017-2018 and (2) 2016-2018 program ABIM pass rates as proxies for program quality. Key independent variables were hospital type (community-based, community-based university-affiliated, or university-based) when program concentration was the outcome, and program concentration when Board pass rates were the outcome. Twenty-five percent of programs were "USMD-dominated," 17% were "DO-dominated," 42% were "IMG dominated," and 16% were "integrated." The chances that a university hospital was USMD-dominated were 32 percentage points higher than that for a community hospital (AME = 0.32, baseline probability = 0.11, 95% CI, 0.17-0.46, P < .001). USMD-dominated programs also had significantly higher pass rates by 4.0 percentage points (AME = 0.04, baseline proportion = 0.90, 95% CI, 0.02-0.06, P < .001) than integrated programs, while DO-dominated programs had significantly lower pass rates (AME = - 0.1, baseline proportion = 0.90, 95% CI, - 0.15 to - 0.04, P < .001). USMDs and non-USMDs systematically cluster in certain types of residency programs and their training may not be equal, as measured by board pass rates.

Feasibility and efficacy of gamification in general surgery residency: Preliminary outcomes of residency teams

BackgroundComprehensive studies evaluating the efficacy of team-based competition (“Gamification”) in surgery have not been performed. Board pass rates and resident satisfaction may improve if surgical residents are involved in competition. MethodsResidents at Montefiore Medical Center (Bronx, New York) were surveyed and separated into teams during a draft. Each resident’s performance was converted into a point system. Resident scores were combined into a team score and presented as a leaderboard. Awards were given. ABSITE, ACGME residency satisfaction, and ABS qualifying exam pass rates were compared. ResultsSixty percent of residents are inspired to improve their performance during gamification. ABSITE average percentile score improved from 28 to 43. ABS qualifying exam pass rates improved from 73% to 100%. Resident satisfaction improved from 65% to 88%. The point system allowed for establishing “growth curves” for each resident enabling enhanced assessment of residents. ConclusionsA comprehensive team-based competition inspires performance, is feasible, and seems to improve ABSITE scores, ABS pass rates, and satisfaction while being a tool for assessment of performance.

An alternate state in mind: the effect of CPA exam credit-hour requirements and economic competitiveness on state-level exam candidate pools and pass rates

ABSTRACTState Boards of Accountancy and other regulators monitor state-wide sit and pass rates on the CPA exam in fulfilling their mission to protect the public. These metrics can prompt important policy decisions such as state CPA exam requirements as well as the accounting curricula and resource allocation at that state’s colleges and universities. Using the test center location of CPA candidates, we analyze the pass rates of U.S. jurisdictions regarding the performance of both in-state and out-of-state candidates. We document that states allowing a candidate to sit for the exam at fewer credit hours (120 verses 150 credit hours) tend to be greater importers of out-of-state CPA candidates. After controlling for a state’s credit hour requirements, we find evidence to suggest that states with high economic activity tend to attract out-of-state candidates that, on average, have better pass rates than do the candidates currently residing in those states. We suggest that our results can assist State Boards, educators, and other stakeholders in making policy decisions regarding the CPA exam environment in their state. More broadly, our study contributes to the literature regarding how state-level rules affect regional competitiveness and the flow of human capital.

39. REACHING 100%: STRATEGIES FOR IMPROVED ACADEMIC PERFORMANCE IN GENERAL PEDIATRICS BOARD EXAMINATIONS

Residency programs are challenged to develop unique and engaging strategies for achieving academic excellence. In-training exams (ITEs) provide formative assessments throughout residents’ development in preparation for the board examination. With an 82% first-attempt board pass rate in 2011, the University of Florida Pediatric Residency program sought to develop novel interventions to reach a pass rate of 100%. Initial strategies included the use of board individualized learning plans (ILPs), designed by each resident to target areas for improvement. While the intervention's intent was to create individualized study curricula, the resultant exam pass rate showed no improvement. In July 2014, team-based learning (TBL) board study groups were formed, demonstrating positive results from 2015 onwards. In 2016, an 18-month didactic curriculum was instituted in Academic Half Day (AHD) as a weekly forum for knowledge building, simulation exercises, and team-building events. These sessions improved the culture of the residency program and provided practical knowledge in a collaborative setting. In 2017, a multimedia bundle, MedStudy, was purchased for the pediatric residents as a tool for board preparation. Following this intervention and the longitudinal AHD curriculum, the Class of 2018 achieved a 100% board examination pass rate. This increase also correlated with an increase in median board examination scores from 194 to 211 (2012 to 2018, see Figure). Overall, a significant improvement in board pass rate was seen from 2012-2018 using a Kruskal-Wallis Test (p

Cardiothoracic surgery mock oral examinations: A single institution's 5-year experience

ObjectivesAlthough in-training examinations provide surrogate data on qualifying exam readiness, use of mock oral examinations (MOEs) in cardiothoracic surgery training before the American Board of Thoracic Surgery certifying oral exam is not uniform. Although MOEs are prioritized by some institutions, development and execution of these labor-intensive, time-consuming exams may be a barrier to others. Therefore, we aimed to develop an MOE program and to assess its educational value. MethodsWe developed an institutional MOE program that mimicked the certification examination and was serially administered to 10 cardiothoracic surgery trainees from 2014 to 2018. Biannual MOE scores were reviewed, along with certifying examination pass rates. MOE data were available for curriculum development and trainee performance evaluations. ResultsMOEs were conducted twice each academic year, with 4 exams administered during each individual's training. MOE program development required significant up-front time commitment, and thereafter each MOE required approximately 24 total faculty hours and 4 administrator hours. The pass rates for sequential MOEs demonstrated gradual improvement, and the corresponding certifying exam pass rate was 100% for these same individuals. MOE data were routinely used for curriculum refinement, as well as individual trainee feedback. ConclusionsStandardized MOEs are useful educational adjuncts to assess trainees' knowledge and readiness for certification exams, but require significant coordination and time to develop an accurate, rigorous simulation mechanism. Although we recognize that improvement in serial MOEs is likely related to exposure as well as expanding funds of knowledge, we believe these results justify use of this assessment tool in training.